My aunt was denied Medicaid. Can the nursing home sue us for payment?
If Medicaid was denied because my aunt's SSI and pension was over $2,000 and she died after Medicaid made that decision, and her house had a mortgage on it, can the nursing home sue us for payment? We are her nieces and nephew, she did not have any children. This is in New York.
Getting to the bottom of your situation may require you to do a bit of talking and wading through some fine print.
First and foremost, you want to be sure that the decision denying your aunt Medicaid was correct. Many older or disabled people, for example, are able to technically exceed Medicaid's income limits and still qualify for benefits if a certain portion of their income goes to paying medical bills. And Medicaid workers are often forced to take another look at eligibility denials, especially once there is an active and informed advocate to force them to do it. Doublecheck the math done in your aunt's case by contacting the local Department of Social Services, which you can find at http://www.health.state.ny.us/health_care/medicaid/ldss.htm.
Second, make sure the nursing home is within its rights in claiming it is owed money. When pressed, the facility should be able to provide an itemized billing for the charges claimed"”along with its written policy on acceptable funding sources.
If the nursing home administrator is not helpful, try contacting the New York State Office of Long-Term Care Ombudsman at www.ltcombudsman.ny.gov. Impartial representatives there are charged with investigating and smoothing over complaints about nursing home care and operations"”and can sometimes be helpful in untangling billing matters, too.
Finally, if the Medicaid denial is accurate and the nursing facility is rightfully owed money, it may be entitled to claim the amount it is due from your aunt's estate"”and if you are your aunt's sole heirs, that may mean money coming from your pockets. But even in this worst case scenario, there may be some wiggle room for you to negotiate the amount it will take to settle the bill.
If a substantial sum of money is involved, it may be worth your time and money to consult an attorney for help. But not just any attorney will do. Make sure you find someone who is experienced in handling elder law and estate planning issues.
I don't know about New York, but I was told in the State of Georgia, that my mother-in-law must make less than $2,200.00 per month to qualify for Medicaid to help pay for her nursing home care, and I guess that could vary in every state. She does have a small pension too, and her social security amount, and we are now waiting to hear the decision from the Medicaid office. They did ask us how much she pays towards her secondary insurance and her prescription plan and of course they subtracted the amount that is taken out to pay her Medicare insurance, but other than that, they really didn't care that she had other outstanding bills. My mother-in-law rented, and her car was one of our cars initially, but they did call and ask about it too, and it is a 1993 Pontiac Bonneville, and I told them that we now have it, but it needs lots of work! She doesn't own any stocks or bonds, but they did want to know the amount of her life insurance too, which was a very little amount. The lady at the nursing home, who was helping me file for her Medicaid, said that my mother-in-law will most likely qualify. We were wondering too, what happens if she is turned down? She was being covered by Medicare and her secondary insurance, and when that was used up, she is now considered a Medicaid pending patient, which would also be what your Aunt was considered. I agree with Barbara Kate Repa, and I would appeal the Medicaid decision, and ask them to review any and all medical bills that your Aunt might have had, and make sure that they took into account what she paid out every month in Medical insurance and prescription plans, etc. It amazes me that your Aunt, for instance, who worked all her life, and now draws a pension, which of course adds to her income, could not qualify for Medicaid to help pay her final nursing home bills, when she probably never needed the government's help before now! If in the end, you don't come up with any help from Medicaid, I would certainly try and negotiate the final nursing home bill. Hang in there and God Bless You!
Wouldn't it be the patients estate that could possibly be sued but not the relatives? How could anyone (non-spouse) be personally responsible for someone else's medical expenses?